January 4th, 2008


All I'm hoping for is a president who isn't absolutely awful. You have no idea how much I want to get back to ordinary levels of stupidity, viciousness, and incompetence.

In that spirit, I'm considerably relieved by the results in Iowa. Obama seems to be the most innocuous candidate[1], and while unless I've missed something I disagree with everything in Huckabee's platform, at least he isn't running on a "I'm cool because I'm mean" theme.

On the other hand, and not to indulge in conspiratorial libel, there are quite a few candidates who have a lot to gain from a terrorist attack on the US before the election.

[1] I strongly agree with Paul's stand on the war on drugs, and he's the only pre-candidate that stand, but he's too flakey otherwise for my taste. The Democratic candidate is going to have to be utterly superb pie crust to get me to vote for Paul.

The Best Prosecutor of 2007


After his election, Watkins instituted significant reforms to the way Dallas fights and prosecutes crime, including major changes to the way police conduct lineups and interrogate suspects. He stopped the inexplicable tradition of destroying death penalty files after conviction, which is often a barrier to DNA-based innocence claims down the line. He fired overly aggressive subordinates, and caused still more to resign in protest or frustration.

But most notably, Watkins not only hasn’t fought innocence and wrongful conviction claims, he’s been seeking them out, correctly understanding that a prosecutor’s job isn’t to see how many people he can throw in prison, it’s to work toward the fair administration of justice.

Medical Ethicists, public health hazard

Checklists in ICUs are made illegal.

The results were stunning. Within three months, the rate of bloodstream infections from these I.V. lines fell by two-thirds. The average I.C.U. cut its infection rate from 4 percent to zero. Over 18 months, the program saved more than 1,500 lives and nearly $200 million.

Yet this past month, the Office for Human Research Protections shut the program down. The agency issued notice to the researchers and the Michigan Health and Hospital Association that, by introducing a checklist and tracking the results without written, informed consent from each patient and health-care provider, they had violated scientific ethics regulations. Johns Hopkins had to halt not only the program in Michigan but also its plans to extend it to hospitals in New Jersey and Rhode Island.

The government’s decision was bizarre and dangerous. But there was a certain blinkered logic to it, which went like this: A checklist is an alteration in medical care no less than an experimental drug is. Studying an experimental drug in people without federal monitoring and explicit written permission from each patient is unethical and illegal. Therefore it is no less unethical and illegal to do the same with a checklist. Indeed, a checklist may require even more stringent oversight, the administration ruled, because the data gathered in testing it could put not only the patients but also the doctors at risk — by exposing how poorly some of them follow basic infection-prevention procedures.

I think of medical ethicists as the people who keep saying "but maybe longer, healthier lives are a bad idea", and I don't know of any good they've done. Am I doing the field an injustice?

For more about ICU checklists and other practical ways of improving medical outcomes, see Gawande's Better: A Surgeon's Notes on Performance.

Link thanks to inquisitiveravn.